• Residential substance misuse service

Westcliffe House Limited

Overall: Good read more about inspection ratings

12 Madeira Road, Weston Super Mare, Somerset, BS23 2EX (01934) 629897

Provided and run by:
Westcliffe House Limited

All Inspections

04 February 2020

During a routine inspection

Our rating of this service improved. We rated Westcliffe House as good because:

  • The premises where clients were seen were safe and clean. The service had enough staff. Staff followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to a range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a team and with relevant services outside the organisation.
  • Staff treated clients with compassion and kindness, and understood the individual needs of clients. They actively involved clients in decisions and care planning.
  • The service had a strong sense of community engagement and responsibility, and had been nominated for national awards in recognition of their community work.
  • The service was easy to access. Staff planned and managed discharge well.
  • The service was well led. Governance processes had improved since the previous inspection and ensured that the service ran smoothly.

However:

  • Not all clients had risk assessments and risk management plans reflecting the assessed risks in their files on the day of the inspection. Clients did not all have early exit or discharge plans in their individual records.
  • Medication audits were in place, but were not always sufficient to pick up medication errors or to evidence action to address issues or errors.

Tuesday 4 December 2018

During a routine inspection

We rated Westcliffe House as requires improvement because:

  • The unit did not have clear governance systems that could provide assurance that the service was delivering safe, effective care. The manager had not yet implemented systems and processes which meant they could record, review and audit information about the clients and their service despite this being raised as a concern on two previous inspections. The manager needed to update and review information about the service. This included information about staff training, staff supervision and appraisals, policies, staff files, client care records, risk assessments, incidents, complaints and client medication.
  • There was no evidence of harm reduction advice provided, no evidence of the alcohol use disorders identification test (AUDIT)) or the severity of alcohol dependence questionnaire (SADQ) completion in clients’ care records
  • Although staff stored, administered and recorded medicines safely, the medication policy and procedures to support staff administering medicines were limited and did not cover all aspects of the safe management of medicines. There was no evidence of staff being signed off as competent following medication training.
  • There was little evidence to show that staff were up to date with their mandatory training. The manager did not have a clear training matrix in place to identify when staff had received, were due or were competent in their training. It had not been identified that staff who were first aiders had expired training certificates, and should have received refresher training.
  • Staff meeting minutes were not easily located or filed in the appropriate place. There was no evidence of staff learning from incidents and adverse events.
  • Client’s physical and mental health problems were not fully reflected in some of the care plans and risk assessments. Risk assessments could have included more individualised detail and crisis plans. Staff did not record information about unplanned exits in clients’ care records.
  • Staff did not have a good understanding of the Mental Capacity Act. This meant that clients who might have lacked the capacity to make some decisions at a certain point of their treatment, including the impact of substances, were at risk of not being represented appropriately.
  •  The service did not have a formal admissions policy. There was a potential risk to other clients and staff of admitting an unsuitable client due to not having a formal admission policy.

However:

  • The service was well staffed and had a low turnover rate. Staff had worked at the service for a long time and demonstrated a deep understanding of the service’s recovery model. Staff treated clients with compassion and dignity. Clients described a culture of honesty and openness within the service and said they trusted the staff team.
  • Clients felt as though changes had been made as a result of their feedback. Staff supported the involvement of families and provided support to develop and maintain these relationships.
  • Staff offered a wide range of therapies and reviewed these regularly with the client to ensure they were effective. Clients had lots of activities to choose from, especially in their local community. There was a strong emphasis on education which included clients educating each other about their culture, heritage and life stories. Staff supported clients to live healthier lives.
  • Clients said that they felt the environment was homely and could personalise their bedrooms. The service documented lots of compliments and had thank you cards displayed around the building. Clients said the food was good and staff had a good knowledge of how to support people who had specific dietary requirements.
  • Staff and client morale was high. Staff felt happy about coming to work and felt proud to be working at the service. The manager respected and empowered the staff team. The manager had identified areas for improvement working with employers of clients with addiction. The manager demonstrated how they had successfully raised awareness about keeping people in employment with employers and the wider community. Staff felt supported by the manager.

This was the third time the service has been issued a requirement notice due to concerns about the governance of the service under regulation 17 of the Health and Social Care Act 2008. We have discussed this with the provider and will return to inspect the service to see if they have made the necessary improvements and to consider further action if the requirement notice has not been met.

09 May 2018

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

Our last comprehensive inspection of Westcliffe House was in December 2016. At that inspection, we issued five requirement notices. Issuing a requirement notice notifies a provider that we consider they are in breach of legal requirements and must take steps to improve care standards.

On 9 May 2018 we undertook an unannounced, focused inspection to see whether the provider had made the required improvements. We found that the improvements were either underway or complete.

  • Since the previous inspection, the provider had started to update their policies and staff records.

  • The provider had also completed work to ensure the privacy and dignity of patients was respected at all times.

  • The provider had ensured that incidents were recorded and learning was acted upon and disseminated to all staff.

However:

  • Further work was needed to ensure the provider had the appropriate systems in place to ensure that all staff had regular recorded supervision and that all staff had completed the training needed to undertake their roles.

14 December 2016

During a routine inspection

We do not currently rate independent substance misuse services.

We found the following issues that the provider needs to improve:

  • Westcliffe House Limited had a philosophy around how treatment was delivered and staff knew what this was. However, at the time of the inspection we did not see this written down for anyone new coming into the service. The provider did not have an overarching governance structure. Policies and procedures were not robust and outcomes were not recorded. This meant staff could not be sure that they were delivering a service that met national best practice. For example those set out in the Drug Misuse and Dependence UK guidelines on clinical management.
  • Some monitoring systems and processes were in place. However, these were not effective. Medicine charts had numerous gaps where staff had not regularly signed for refused or omitted medicines. Staff were not reporting medicine errors or learning from incidents. Generally policies, including safeguarding and incident reporting, had not been updated.
  • Staff told us informal supervision took place and therapists attended external clinical supervision. However, this was not regular or documented and staff had not received an annual appraisal. We saw a training programme and staff undertook National Vocational Qualifications. However, the competence of support volunteers to do a number of aspects of their job had not been assessed. For example, the administration of medicines. Recruitment files were in place. However, we found staff working at the service did not have evidence of a Disclosure and Barring certificate on file and staff who had previously been convicted of criminal offences did not have references or risk assessments in place. Staff had also not updated all other policies, including safeguarding and incident reporting.
  • The service had a health and safety environmental risk assessment, including fire risk assessments. However, staff had not recorded that the building did not accommodate clients with limited mobility. The provider did not have a policy to explain the reasons for this or demonstrate how they had referred clients to an alternative service that could accommodate them. The manager had also not recorded on the assessment that the taps in all the bathrooms and bedrooms were ‘push on’ providing only a small amount of water with each push and did not have free flowing water for staff, clients, and other people coming into the service to wash their hands effectively after visiting the toilet
  • Staff communicated with each other regularly throughout the day. However, they did not formally document a daily handover of client information at the end of each shift, so it was unclear how they demonstrated that they monitored client progress. We also found client sensitive information in a room with the door open so that anyone could access it.
  • We found shared bedrooms did not have privacy screens separating the beds and in one room, the ensuite shower had no wall. This meant clients had to agree not to be in their room whilst the other was taking a shower. This compromised client’s dignity and privacy.

However, we also found the following areas of good practice:

  • There was good communication between the provider and partnership agencies that referred clients to them. Referrers we spoke to were positive about the care given.
  • Clients felt supported and cared for by staff. They stated that the therapeutic programme provided by the service kept them safe and supported their recovery.
  • Staff actively engaged with families, providing support and information to enable them to support their relative who was in recovery.
  • Carers we spoke with told us they were pleased with the support their family member received.

14 November 2013

During a routine inspection

We visited Westcliffe House and met with the provider, the deputy manager and a specialist therapist. We also spoke with six people who used the service and one person who worked informally as a volunteer. We were told by people the service was well led and responsive to their needs. People told us "I have a program arranged to meet my needs, which is reviewed and changed if needed" and "the program is flexible and I can repeat specialist groups if I need them". We also heard from people that "it is important that the boss is around a lot and is approachable" and "the provider is on your side, it's good to have her in your corner because people tend to listen to her".

We saw the service was effective because people were consulted and informed consent obtained before any treatment was provided. People told us "I am not pressured into anything" and "the staff are skilled at ensuring you make choices that enhance your treatment".

People told us that they chose to go to Westcliffe House because the program was holistic and looked at all aspects of a person's life. For example, we heard from people "support workers act as a role model and have empathy and understanding around my difficult experiences" and "the focus here is on self- empowerment".

We looked at the policy and procedure in respect of complaints. We were told by people who use the service that "we can raise concerns at any time, with any member of staff". We saw that medicines were managed safely.

18, 22 October 2012

During a routine inspection

We inspected Westcliffe House over two days; on the first day we spoke with five of the eleven people who lived in the home and looked at the care plans for those people. On the second day we spoke with the manager and staff, looked at personnel files and records kept to ensure the safe running of the service.

People spoken with were very complimentary about the level of support they received from the manager and staff to achieve their goals. One person told us, 'Never thought I'd say it but they have given me my life back. The therapists are brilliant.' Another person told us, 'The therapists are brilliant, the programme is working well, and I feel safe here.'

We spoke to people about how they felt they were involved in the running of the home. People told us that they attended regular house meetings when they would discuss any issues and pass them onto the manager. People confirmed that they met with the manager on a Sunday when they would speak directly about any issues in the home or their treatment programme.

We found that care planning was person centred and agreed with the individual, regular reviews were carried out and involved the individual. Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the manager/provider. The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.